Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment
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RESEARCH
Open Access
Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment Jeff Dunn1,2,3†, Shu Kay Ng1†, William Breitbart4, Joanne Aitken1,2,5, Pip Youl1,2, Peter D Baade1,2,5 and Suzanne K Chambers1,2,6,7*†
Abstract Background: This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors. Patients and methods: A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors. Results: Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain. Conclusion: Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors. Keywords: Longitudinal, Cancer, Survivorship, Quality of life, Colorectal
Background With nearly three quarters of a million people diagnosed in 2008, colorectal cancer is estimated to be the most common incident cancer in the developed world [1]. In 2008 there were an estimated 3.3 million people living with a diagnosis of colorectal cancer within the previous 5 years [1]. Although there has been a decrease in incidence rates * Correspondence: [email protected] † Equal contributors 1 Griffith Health Institute, Griffith University, Queensland, Australia 2 Cancer Council Queensland, Queensland, Australia Full list of author information is available at the end of the article
in Australia [2], as in the United States [3], the numbers of people diagnosed with colorectal cancer (CRC) each year continue to increase [2]. Despite having one of the highest incidence rates in th
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